Osseous Tumors in Children

This benign, bone-producing, highly vascular tumor induces an intense bony reaction and a characteristic pain pattern. These tumors occur most commonly in long bones during the second decade.

Diagnosis The pain typically occurs at night, is well localized, and is often relieved by aspirin. Spine lesions occur in elements of the spine and may cause secondary scoliosis. Lesions are tender and, if close to a joint, cause joint inflammation that may be confused with primary arthritis. Lesions may cause hemideossfication due to chronic pain and a limp. The radiographic appearance is often characteristic for well-established lesions. A radiolucent nidus is surrounded by reactive bone. The bone scan is diagnostic, with intense localized uptake at the nidus. Image with MRI and CT scans to fully evaluate the lesion.

Management New options for management supplement the traditional approach of open excision.

Antiinflammatory Lesions eventually resolve over many years. This option is rarely acceptable to families.

Percutaneous ablation using CT for localization and radio frequency ablation is preferred in most cases.

Open excision is a reasonable option but carries a risk of an incomplete resection and local recurrence.

Osteoblastoma

This benign bone-producing tumor is similar to the osteoid osteoma but larger and shows clear differences. Pain is less intense and not relieved by aspirin. Lesions are not surrounded by reactive bone. One-third of these lesions causing back pain and often scoliosis and sometimes localized tenderness. CT and bone scans are useful. They are sometimes difficult to differentiate from osteosarcoma. Spinal lesions are most difficult to manage because of the adjacent vertebral artery in a cervical spine lesion. Manage by complete resection.